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OAC 365:10

INSURANCE DEPARTMENT

      • (B)

        Advertising costs;

      • (C)

        Commissions and other acquisition costs;

      • (D)

        Taxes;

      • (E)

        Capital costs;

      • (F)

        Administrative costs; and

      • (G)

        Claims processing costs.

    • (3)

      All filings of rates and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this section when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards.

    • (4)

      For purposes of applying (a)(1) of this section and (c)(3) of 365:10-5-132 only, policies issued as a result of solicitations of individuals through the mails or by mass media advertising (including both print and broadcast advertising) shall be deemed to be individual policies.

    • (5)

      for policies issued prior to July 1, 1992, expected claims in relation to premiums shall meet:

      • (A)

        The originally filed anticipated loss ratio when combined with the actual experience since inception;

      • (B)

        The appropriate loss ratio requirement from 365:10-5-131(a)(1)(A) and (B) when combined with actual experience beginning with July 1, 1996, to date; and

      • (C)

        The appropriate loss ratio requirement from 365:10-5-131(a)(1)(A) and (B) over the entire future period for which the rates are computed to provide coverage.

  • (b)

    Refund or credit calculation.

    • (1)

      An issuer shall collect and file with the Commissioner by May 31 of each year the data contained in the reporting form contained in Appendix Q of this Chapter for each type in a standard Medicare supplement benefit plan.

    • (2)

      If on the basis of the experience as reported the benchmark ratio since inception (ratio 1) exceeds the adjusted experience ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis for each type in a standard Medicare supplement benefit plan. For purposes of the refund or credit calculation, experience on policies issued within the reporting year shall be excluded.

    • (3)

      For the purposes of this section, policies or certificates issued prior to July 1, 1992, the issuer shall make the refund or credit calculation separately for all individual policies (including all group policies subject to an individual loss ratio standard when issues) combined and all other group policies combined for experience after the 1st of July, 1998. The first report shall be due by May 31, 1998.

    • (4)

      A refund or credit shall be made only when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. Such refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the Secretary of Health and Human Services, but in no event shall it be less than the average rate of interest for 13-week Treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.

  • (c)

    Annual filing of premium rates.

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